The article by Saloviita and Sariola (2003) was written as a commentary to our article (Niemi & Kärnä-Lin, 2002). We are delighted to discover that our article has inspired other researchers to re-study our case. In fact, one of our original intentions was to evoke and redirect the discussion on authorship in facilitated communication by introducing a novel perspective to this communication disorder, namely, the perspective of linguistics and grammar. However, as we will show below in our response to their commentary, the re-analysis offered by Saloviita and Sariola is based on very limited data and, subsequently, the focal interpretations of the authors do not give justice to the case of Tuomas Alatalo.
First of all, it needs to be stressed that the focus of our article was on a linguistic and grammatical analysis of Tuomas' texts, not on the case of Tuomas Alatalo. Thus, our purpose was to pay due attention to the central element of facilitated communication, namely, language (i.e., written text), which has attracted amazingly little interest among researchers, although language is a key element of this population. Acknowledging this, we firmly believe that in order to understand the process of facilitation more completely, we need such multidisciplinary research and cooperation as reported in our article.
We would like to start our counterargument with our esteemed commentators with the notion that Saloviita and Sariola (2003) paid hardly any attention to the actual findings of our study. This is odd, because we are dealing with an empirical approach. Instead, Saloviita and Sariola merely made the following laconical comment:
Actually, it is quite easy to interpret the linguistic peculiarities presented by Niemi and Kärnä-Lin (2002) as consequences stemming from errors made by the facilitator. When a typing “error” occurs, the facilitator is still able to end up with an acceptable sentence if she is ready to break some linguistic rules of conventions. The alternative explanation for the results of Niemi and Kärnä-Lin (2002) is as simple as that. (p. 378)
As a response to this we first of all wonder how the linguistic peculiarities remain unchanged in Tuomas' texts regardless of his facilitators? Are all his facilitators as aberrant (and similarly so) as Tuomas' text seems to indicate, provided we adopt the Saloviita and Sariola interpretation? More specifically, it is strange that these facilitators would produce, perhaps in a conspiratory manner among themselves and with Tuomas, and subsequently through Tuomas, extremely long stretches of textual narratives with similar, isomorphic and even identical structural and semantic peculiarities that are pervasive characteristics of Tuomas, and only of Tuomas, among the plethora of speakers and writers of Finnish that we have, or for that matter, any Finnish speaker has encountered. In more general terms, a theoretical statement in a scientific debate should be tested, perhaps then falsified and eventually even replaced with another construct of identical status. The crux of our argument is that Saloviita and Sariola did not give readers any alternative scientific explanation for this persistent complex of observations that is here, for short, called Tuomas' written language output.
The main focus of the Saloviita and Sariola (2003) commentary is on the case of Tuomas Alatalo. As it was not possible to introduce our case in a detailed way in the original article, we would like to provide some additional information on him in the present response. Perhaps the following description of his case will clarify the issues at hand. When facilitated communication was introduced to Tuomas in 1993, he had very limited means of expressing himself. While typing, he needed physical assistance mainly for isolating his typing finger and for pulling back his hand from the keyboard after each keyboard selection. At that stage it was also important that his posture was good enough for typing. At the beginning Tuomas was able to write only single words. However, during the course of about one year, he became able to communicate with sentences; but still the number of the sentences in one session was very low. Typing was also a physically strenuous task for him due to dystonia. In about a year his mother and his speech therapist were able to move their support up to his elbow. However, the support he needed from other facilitators, who were new and not so familiar with him, was more extensive, and even today the amount and kind of physical support that Tuomas needs for writing depends on the facilitator as well as on the physical elements of the writing context. On a few occasions when Tuomas' position was been optimal for pointing, he was able to type single words independently but, generally speaking, he still needed some physical assistance while typing. In his book Tuomas described the facilitation process in the following way: “Facilitation requires a person who is especially persistent and appreciative and who has an ability to make the situation safe throughout. It [i.e., facilitation] requires a person who does not in the least try to guide you but who allows the writer to write her/himself, even though she/he might disagree” (pp. 49–50, as translated by the present authors; the latter comment is transferable to all the following quotes from Tuomas' book). Similar accounts on the facilitation process have also been published by other people using facilitated communication (see, e.g., Marcus & Shevin, 1997).
The person who facilitated Tuomas in the TV program that was mentioned in the commentary article by Saloviita and Sariola (2003) was not as experienced a facilitator as, for example, Tuomas' mother or his speech therapist. Thus, her support to Tuomas was firmer than the support Tuomas usually needed from facilitators familiar to him (see above). We also stress that—understandably enough—situational aspects, such as anxiety and stress, have been shown to have an adverse impact on the facilitation process (Olney, 1997). It is obvious that a first-time appearance on a TV program focused on his own life must have been very exciting and unnerving for Tuomas. We claim that it was for these, quite natural reasons (novelty of facilitator and context) that he needed more extensive physical support for typing in the TV program. As a final remark on this topic, we emphasize that a 30-second clip from a TV program, to which the authors here refer, can hardly provide a representative evidence of Tuomas' linguistic abilities and his ability to type. We remind readers that in empirical science, the extent and quality of the observable data do count, especially when negative evidence (“no evidence of Tuomas' independence,” à la Saloviita and Sariola) is used to undermine positive evidence (“positive evidence of Tuomas' independence,” à la Niemi and Kärnä-Lin).
Turning now to Tuomas' sensory capacities, we are first to admit that—as Saloviita and Sariola also indicated—Tuomas has hearing problems in that his hearing is oversensitive and it is hard for him to tolerate loud and sudden sounds. However, auditory training therapy has helped him to overcome some of these problems but not all. Taking into account both Tuomas' special characteristics of hearing and his motor problems, we can conclude that vision has been the most important and accurate distal sense for him. Based on Tuomas' own description of his visual world, it can be further assumed that his visual processing system works in a unique pattern. “Thanks to my unique visual system and memory I have been able and I am still able to record the events of my life to my memory as filmstrips” (p. 33). Similar accounts can be found from the literature: For instance, Prizant (1983) and Prizant and Schuler (1987) stated that individuals with autism have been described as operating in a “gestalt” fashion, which means that both visual and auditory information is stored as unanalyzed wholes to be later reproduced in an identical fashion. Das (1984) called this kind of information processing “simultaneous.” Tuomas' recurrent accounts on his ability to memorize things “at one glance” is a further indication that he is able to use his iconic memory unusually well. Earlier researchers on the issue assumed that iconic visual memory was virtually a photographic image of the world at a specific moment in time (Spearling, 1960), but recent researchers see iconic processing as a two-stage process. The first stage involves the processing of a literal image of the information and the second stage is a character buffer, where the processing of the abstractions of the information from the feature buffer occurs (Parente, Kolakowsky, Hoffman, & Blake, 1998). Parente et al. (1998) further suggested that iconic memory training is possible and will have positive impact on the speed of the processing of visual information.
The unique ability to store visual information that Tuomas also frequently referred to is connected to the ability to learn to read. However, according to Saloviita and Sariola (2003), there is no evidence in their data that Tuomas is able to read on his own. The only piece of datum that they have is a fragment from an interview of Tuomas' mother, in which she told that she learned from Tuomas' gesture that he was able to read. The authors further wonder how a single gesture can be distinguished from all other gestures. For many people with severe communication problems gestures are the most useful means of communication even though they may not always be as accurate as words or established sign-language signs of the hearing-impaired. However, those who work with people with severe communication problems usually learn to understand and interpret their messages. According to our interview data, Tuomas had indicated several times that he was able to read. For example, Tuomas' mother said that in a car Tuomas was usually seated in the back seat so that his mother or father could see his face from the rear-view mirror. Prior to the use of facilitated communication, Tuomas' mother had noticed that Tuomas always got more focused when they were approaching a commercial sign or a billboard. One day Tuomas' mother eventually asked whether he was able to read the texts of these boards. Tuomas confirmed it by a gesture (nodding his head). In his book Tuomas illuminated his reading process in the following way:
I usually collect information visually. My vision is unbeatably superb. For example, I can read one page in one quick glance. I do not claim that I am able to memorize everything but if I think that I need some texts I will store them in my long term memory. (p. 54.)
I memorize words as pictures. (p. 52). … So I was at school but I could not tell that I was able to read. I could not guess that the others were not able to read because I thought that reading was like quiet speech that everybody knew. (p. 29.)
Those years during which I lived without any belief in writing were hard because I simply did not have the guts to tell even through pictures that I had been able read and do math ever since my first school year. My mother Hilkka did not have any idea of it either because I regarded it [i.e., reading ability] as meaningless information. I thought that all of us disabled people are able to read. (pp. 32–33)
The examples above can be interpreted as describing Tuomas' unique way of reading by using his iconic memory. It is also to be noted that most reading begins with the visual analysis of the texts and most beginning readers, in fact, rely on visual memory more than on verbal memory (Gang & Siegel, 2002). If the visual analysis is not performed accurately or it is very slow, the reading process will slow down or it will be completely restrained. The visual elements of the reading process are also important at later stages during which reading becomes more automatic or routinized (Gang & Siegel, 2002; Stanovich, 1986). Buzan (1983, 2002), a leading teacher of advanced reading techniques, goes as far as suggesting that automatic reading processes can be made faster and more accurate by practicing the effective visual input. According to him we can take in more information into our iconic stores and short-term memory stores by utilizing peripheral vision. Moreover, by eliminating backtracking, we can reduce the time spent on reading redundant information; and by practicing speed reading, we can decrease the number of errors and increase our comprehension. Thus, the expected “law” of speed versus accuracy tradeoff is not directly applicable to these peripheral events. In sum, and as we have suggested earlier, Tuomas seemed to have unique visual skills and that those skills facilitated rather than prohibited his acquisition and development of reading ability.
The unusually developed visual sense of Tuomas is also connected to the issue of eye focus. In their commentary Saloviita and Sariola (2003) pointed out that “It is obvious that writing accurately with one finger in the air and no reference to the keyboard is simply impossible” (p. 376). However, they do not specify where and how Tuomas' eyes were focused when he was not looking at the keyboard. Neither do the authors specify the amount and frequency of gaze focus on the keyboard. Thus, they give a very limited amount of evidence for their straightforward statement. The alternative interpretation is that in the process of seeking novel visual information, Tuomas does tend to focus his gaze on keyboard and that the occasional unusual events of migrating eye focus are connected with his hearing and motor problems as well as to his unusual fast and “iconic” way of using his visual sense as discussed above. Thus, the facts that Tuomas' eyes occasionally did not seem to focus on the keyboard does not mean that he did not see or focus on the keys he was motorically aiming at. Instead, an opposite explanation can be given by referring to a growing number of articles on peripheral vision, as follows. The unusual eye focus has been reported particularly in the literature on autism. For example, Oppenheim (1974), who used facilitation to train her students with autism to carry out independent handwriting, pointed out that “many autistic children seem to have better peripheral than foveal vision so that very often when it appears that the child is not looking, he may, in fact, be seeing precisely what the teacher wants him to look at” (p. 41). Furthermore, in a number of recent studies (Proteau, Boivin, Linossier, & Abahnini, 2000; Seppa, 2002), researchers have stressed the importance of the role of peripheral visual information in the control of aiming movements and have shown that people with blank or fuzzy spots at the very focus of their vision can be retrained to use the peripheral areas of their vision. In addition, it has been discovered that deaf people in particular display a unique pattern of activity in the brain's visual system that might strengthen their peripheral vision. Recently, a group of neuroscientists found that individuals who are deaf regularly scan their surroundings to compensate for the absence of acoustic cues and typically monitor the arm and hand motions of sign language with peripheral vision (Bower, 2000). Thus, we claim that although Tuomas' eyes sometimes seemed to focus on the context external to his keyboard, he could have been able to monitor his movements by an efficient use of his peripheral vision. Note also that—as noted by Tuomas himself—he memorized the order of the keys as a picture. The active use of his peripheral vision may also have facilitated him to resort to this mode. However, it needs to be stressed that, in general, the eye focus on the keys or letters has a facilitatory effect even for Tuomas, because it seems to make the writing process faster and more accurate. Over the years, Tuomas has also become more skillful in keeping his eyes focused on the keys of the typing equipment.
The problems of passing messages in a controlled situation are not unique to Tuomas Alatalo either. According to other investigators (Baldac & Parsons, 1997; Marcus & Shevin, 1997), the controlled message-passing tests have been difficult for people using facilitated communication. The authors stressed that the failures were not necessarily an indication of the person's inability to write. Instead, they pointed out that there are factors in the testing situation that affected performance in facilitated communication. Thus, if a controlled testing situation is arranged, these possible interfering factors should be taken into account. This was not the case in the message-passing situations that were described in his book. In real life situations, however, Tuomas has revealed information unknown to the assistant. For example, a few years ago a new facilitator started to work with Tuomas. After some months Tuomas told his mother, who facilitated him, that he was worried about his new assistant as she did not eat during the day. Later, his mother called the assistant who confirmed the message to be true.
In their commentary Saloviita and Sariola (2003) claimed that “stories turn very brief when life events are described in which the mother is not present.” The claim is based on an example of Tuomas' 2-year stay in a boarding school. According to Saloviita and Sariola “2 years of Alatalo's life is summarized very shortly. The description of these years almost remains at the level of a passing comment: “Of course, many events occurred in two years” (p. 377). We believe that Saloviita and Sariola's claim is hastily made, without solid evidence and a correct knowledge of the writing process of the book that they use as their data basis. They based their claim mainly on one of Tuomas' citations from the book. Yet, they do not tell readers that the book contains many other examples of Tuomas' life at the boarding school. One of the chapters in Tuomas' book is, in fact, called “Lehtimäellä” [‘At Lehtimäki’], which is the name of the boarding school. In this 2-page section Tuomas described the feelings of moving away from home, the opening ceremony of the school year, the social atmosphere of the school, and some other events in which he participated (pp. 45–46). Some pages later in a chapter on women he tells his readers about the life with his female schoolmates at the Lehtimäki school (p. 94). A third long mention on Lehtimäki is found in a chapter on friendship, in which Tuomas wrote about his disappointment concerning the academic work and his limited possibilities for communication, for instance, as follows:
How can I tell what I want when I write so slowly and pathetically with new facilitators [Note his self-awareness of the adverse effect of unfamiliar aides]. I did not have a facilitator in class and thus I did not have a chance for mutual communication. (p. 98)
In our mind these examples are not tantamount, but paramount to “a passing comment.” Our second argument is that Tuomas Alatalo's book is neither a traditional autobiography nor a validation study on facilitated communication, even though Saloviita and Sariola (2003) seemed to interpret it as such. Rather, it is a literary volume that includes both written material produced in real life situations and texts that Tuomas wrote particularly for this book. The final version of the book was edited by Jukka Parkkinen, a well-known Finnish writer, whose writing courses Tuomas had attended.
With regard to age appropriateness, Saloviita and Sariola (2003) briefly pointed out that many reviewers of the texts admitted that they were exceptionally mature. The book however, contains several age-appropriate stories of girls, school, future, etc. One should also remember that when Tuomas wrote most of the texts of the book, he was already a young adult. As he also indicated, the stories of the book are based both on his own recollections and on the stories told about his life. Thus, Tuomas' book is a story of his life, the many portions of which were written ex post facto, and eventually edited, as discussed above. When talking about sex-inappropriateness, Saloviita and Sariola provided us only with a short fragment from the book as their evidence in the following way:
Gender-appropriateness of the text is threatened in a fragment where the (male) writer describes sexual excitement as follows: “A small irritating feeling from inside announces: be careful that the pants don't get wet” (p. 377).
Those who are familiar with Tuomas know that it was exactly what happened to Tuomas in his teenage years when he, for example, looked at pictures of naked women. In addition, the meaning of the fragment is even more unambiguous when it is compared with other fragments of sexuality in the book. The book contains, for example, two texts that Tuomas wrote at a writing course that he attended. In those texts Tuomas described his feelings of getting an erection when a beautiful girl came to take him to the shower. In addition, the book contained many other fragments in which Tuomas talked about his wishes and fantasies related to the opposite sex. Our overall interpretation here is that the texts of the book are both age- and sex-appropriate.
The risks that Saloviita and Sariola (2003) associated with facilitated communication are the creation of false personae and the elimination of previously effective communication. According to them the book is full of examples of his struggle against being facilitated and his failed attempts at delivering his real message. We feel that the examples such as “I am grateful that my mother has firm confidence in me and remains to facilitate my writing, although I try to interrupt it—by yelling” can be interpreted in the opposite manner. In fact, the book contains several statements in which Tuomas described the feelings of being facilitated and the elements needed for successful facilitation. Rather than telling about his struggle against facilitated communication, the fragments provide us with useful first-hand information on the complicated facilitation process as experienced by the subject himself. Finally, the use of facilitated communication has in no way eliminated or replaced Tuomas' other alternative communication methods, such as gestures and facial expressions.
The final point made by Saloviita and Sariola (2003) is the professionals' responsibility for the acceptance of the authorship of facilitated communication. The issue is admittedly important and relevant, but they need to clarify the evidence they provided: The actual evidence that led the well-known child psychiatrist to vouch for Alatalo's authorship was explained as follows: “When I looked into the eyes of Tuomas, there could be no question that before me was an intelligent, feeling and experiencing persona” (p. 378). To help our readers, it needs to be noted that the fragment is taken from the Foreword to Tuomas Alatalo's book and that the statement was not based only on the single impression of Tuomas as described in Saloviita and Sariola's commentary. Rather, this was the way the ball was played: After this first appointment and encounter with Tuomas, Dr. Sinkkonen wanted to know more about facilitated communication and, subsequently, he went to see Tuomas at school. After several trials Tuomas wrote the two words forgive me while Sinkkonen facilitated him. This own facilitation experience together with his private sessions with Tuomas gradually convinced Sinkkonen of the notions that Tuomas was the original author of the texts. In addition to Sinkkonen, there are other very experienced, well-known Finnish professionals of different fields who have now accepted facilitated communication as Tuomas' means of communication. Many of them have known Tuomas ever since he was a small child, and, thus, their acceptance of facilitated communication is not based just on a few occasional encounters but on a long-term relationship and a thorough knowledge of his development. In addition, professionals who are dealing specifically with Tuomas' texts (writers, poets) are able to recognize his written output from any other literary material on the base of its unique structure and style (regardless of the facilitator), which was the gist of our original article.
Finally, we stress that the investigation of the authorship in facilitated communication is a very relevant issue. However, the evaluation should preferably be carried out by using multitheoretical approaches and by taking into account a sufficient amount of information relevant to the case under study. Unfortunately, this was not done in the re-analysis attempt by Saloviita and Sariola. The most serious flaw of the enterprise is that their argument is based on a limited amount of indirect data without any contact with Tuomas Alatalo. The fact, however, remains that a considerable number of Finnish people with severe communication problems, including Tuomas Alatalo, have benefited a great deal from facilitated communication. Some of them, after years of practice, have moved from hand-over-hand support to independent typing (in most situations). Some others, like Tuomas, are still working towards more independent communication. However, facilitated communication has provided them with a means of telling about their thoughts and feelings in a manner that has not been available for them ever before. We take them as the living proof of the feasibility method, although its theoretical (psycholinguistic) underpinnings are still a mystery.
Authors: Jussi Niemi, PhD, Professor in Linguistics ( email@example.com) and Eija Kärnä-Lin, PhD, Lecturer in Special Education, PO Box 111, University of Joensuu, Joensuu, Finland 80101